Press Briefing by John Walters, Director of the Office of National Drug Control Policy, and Nora Volkow, Director of National Institute on Drug Abuse on the "Monitoring the Future" Report
James S. Brady Press Briefing Room

DIRECTOR WALTERS: Thank you. As you know, the President announced the
latest results of "Monitoring the Future," the annual survey that has been
done since the mid-'70s, about rates of teen drug use among 12th, 10th and
8th graders. The President noted that in 2002 we set a goal of reducing
overall teenage drug use by 25 percent. Today's results, covering the 2007
school year, note an overall reduction of 24 percent for selected drugs.
Obviously, the widest drug abuse by teenagers and adults is marijuana;
that's been down 25 percent. This is the overall trend for the three
grades -- the 8th graders being the one at the bottom with the lowest
rates, and some of the steepest declines the 10th and 12th graders, for the
period since the studies existed, since 1975.

This has a summary of the results for different drugs, from 2001 to 2007.
As you see, the rates have changed. You'll note that the overall number --
25 percent decline for marijuana, ecstasy use down over 50 percent,
methamphetamine use down 64 percent, alcohol use by this age group --
underage drinking -- down 15 percent, cigarette use down 33 percent.

This highlights the decline we've seen with methamphetamine use in three
categories: those reporting they used in the past month, those reporting
they used in the past year, and those reporting they've used in their
lifetime -- with the month, year and lifetime in that order.

Also, the study asked questions about steroid use. You may remember in the
2004 State of the Union, the President mentioned the problem of steroid
use. We've seen a drop of overall a third. But also, and by month, by
year, and by lifetime, 33, 45 and 45 percent for this age group, which is
also obviously good news; and the effect of these drugs, especially on
growing adolescence, is particularly detrimental.

As the President pointed out, these reductions are a result of hard work by
many, many people and communities; working coalitions; young people;
parents that have been working in these areas; small, faith-based and
community groups; schools; many adults giving time to help young people;
and many young people helping each other. We had a sampling of those
people -- Dr. Volkow and I were with the President and talking to a sample
of a people from around the country working this area from our major cities
to a Native American anti-drug treatment and prevention efforts.

In addition, as the President pointed out, we've seen declines in some
areas of supply. One of the areas we haven't seen a decline that the
President highlighted was prescription drug abuse, particularly pain
killers. The overall decline has been maintained, but within it there has
been during the five-year period an increase and a stubborn resistance to
decline by prescription drug abuse. This is a different problem. These
are certainly dangerous, mostly synthetic opiates that are the most widely
abused. They are not only a source of addiction, but they are of course --
can be a source of seizure, even death, when taken in quantities.

It's also a different problem because the source of supply is different:
71 percent of young people from other surveys we have say they have -- the
source of supply is the medicine cabinets of their own home, and the
medicine cabinets of the parents of their friends in their homes. So this
is a uniquely susceptible problem to education and information. We need to
get people that information, one, to tell young people and parents these
are a dangerous threat, they need to pay attention to them more than ever;
and, two, to shut down the source of supply, which is not having control of
these substances when they're used in the home, when they may be used for
legitimate purposes, which obviously we want people to have access to them.

And secondly, throw them away when they're done. Proper disposal and
control are a key way to help to reduce this, in addition to education.
That's all something we need help getting information out into people's
hands: recognize the problem and recognize what you need to do about it,
in terms of helping to educate young people and to remove this attractive
hazard.

Other than that, I'll be happy -- and help Dr. Volkow to answer your
questions.

Q What's your plan for next year? What drugs will you be focusing on?
Where is drug czar money going to go? What's the emphasis going to be, in
terms of drug testing?

DIRECTOR WALTERS: Well, we'd like to reinforce the things that work.
Sometimes government has problem seeing this, but we've tried to, again,
push a balanced strategy, as the President said, across both supply and
demand. It began with the Access to Recovery program. We're seeking --
and we hope Congress, when it finishes this appropriations cycle, will
continue to give us the resources to expand treatment that follows
individuals and helps to support them in recovery.

Secondly, we want to follow up with the President's initiative on random
testing, as well as strengthening the messaging we do with media campaign
for both parents and for young people directly. We're going to focus on
prescription drugs. I think that we are working with NIDA, with our
nonprofit partners, with community groups to prepare and we're working
aggressively to get these things out in the coming months. Where we have
some things in the works, we'll see whether they prove as effective at
promising, and we'll be rolling them out as quickly as possible because
it's a serious threat.

Q Two questions. One, on the graph you showed with the illicit drug use
-- it looked like, yes, the overall trend of decline was sustained, but
that there seemed to be a leveling off effect, that the declines that we've
seen from the previous year were far fewer than what we had demonstrated in
the past. What could explain that? And then also, as part of prescription
drug abuse, what about the prevalence of these things on the Internet?
I've heard reports of online pharmacies that are -- you can basically get
any prescription drug that you need just by lying about your age and other
things to get these. So what are you doing to address that piece of the
problem?

DIRECTOR WALTERS: Let me take those in reverse order. While most young
people -- through other survey data, as I said, not this survey -- the
preponderance of the drugs they report using in prescription abuse come
from their own homes. There is, obviously, abuse on the Internet. There
have been cases -- the DEA has been involved in pill mills over the
Internet. And we are working aggressively with Congress to move forward
legislation that will help us do a better job of providing regulation and
control.

In addition we've been working with states -- 33 states now have
prescription monitoring programs for patient safety. Doctors can then have
access to a confidential data base, find out whether someone has been
doctor-shopping, whether they've been given an inordinate amount of certain
abusable prescriptions when they present themselves. In addition,
pharmacists can see whether or not a prescription is a forgery or a valid
prescription, or whether it's one that's been also gotten from others. So
it helps both prevent illegal activity, but it also helps patient safety.

On the decline -- different years there has been different rates of
decline. And for some of these categories and for some of the age groups,
the change year to year has not been down, it's been flat. Again, that's
why the overall trend -- again, there are a couple factors to keep in mind.
One, fortunately the majority of young people do not use illegal drugs.
And so what Dr. Johnston is looking at when he does the research is both
the overall number -- and then looking at changes within that, you end up
with smaller and smaller differences, especially year to year. That's why
we've looked over a number of years to kind of see change, also to make
progress.

In addition, we have seen steeper declines with younger -- the younger age
group. It is true that the -- and that's a good thing, because the younger
you start, the more dangerous this is.

And I think the other thing I omitted that I think is important here for
people to understand why it is important what we do here: if you don't
begin using drugs of abuse, alcohol and cigarettes, up through adolescence,
you have a much reduced risk of using afterwards. And if you do use
afterwards, you also have a reduced risk of becoming dependent. Now, it's
not true of every person, there are other factors. And I think there's no
more striking example of that than my generation -- the baby boomer
generation, had as a cohort the largest involvement with drugs and alcohol.
And now we, in our 50s and 60s, have some of the highest rates of
alcoholism and continuing substance abuse of any generation before or
after.

So not only is this good news good today, but this generation will tend to
be less involved with drugs and alcohol and cigarettes for the rest of
their lives. So this is something that has a durable effect on the future
of the substance abuse problem in the country by the basic common-sense, I
think, direction of -- keep kids away from this, and more markets
(inaudible).

But there has been different rates of change in -- but overall, the last
five years have shown, I think, a pretty remarkable decline, and a decline
sustained across a number of dimensions. That's why we're particularly
troubled about prescription drugs, is it hasn't followed that pattern.

Q Sorry, let me just write. Don't want to miss that. You can't write
and talk at the same time. Sorry. (Laughter.)

So on September 6th at the Press Club when we were talking about the other
survey, as I recall, that survey showed that the numbers had basically
stagnated in '06; that the nice drops that we had seen had almost
completely leveled off. And as I recall, what you said was that all of the
other gains in other areas of illicit drug use were basically being negated
by rising prescription drug use. And part of your message that day was
that we were in real trouble, because of prescription use, of not hitting
the President's goals, your goals, for an overall reduction.

It's only three months later and we're on the cusp of victory here. So I'm
a little bit confused about how to interpret whether we're there or not
there. I understand there are two different studies, I understand the
methodology is different, but --

DIRECTOR WALTERS: Well, the age groups are also different. This is a
study of 8th, 10th and 12th graders. The survey is talking about -- is a
national survey on drug abuse and health, which measures people in
households, age 12 and over. So it goes all the way up to young and old.

And part of the discussion, I remember I was talking about, was also, the
initiation rates of this cohort of adolescence in the 8th, 10th and 12th
age group are important. But we also see that the highest rates of use are
by those who are 18 to 26, 18 to 30. And I think what we were talking
about at that point was also the trajectory of use by young adults,
particularly as they affect, because of the intensity of their use, the
over-18 population as a whole. And there, we'd also see an increased use
of prescription drugs. And in that case, we isolate the prescription drugs
-- because you can take the survey data and take out everything but
prescription drugs -- we were talking about that data that showed what
happened, because overall we would have a decline; prescription drug use
had created a kind of flat line.

But that was an older cohort, which is -- but they're still seeing the same
phenomenon. I think, again, we are seeing the prescription drug problem is
not just a problem of teens, it's also a problem of adults. But, again, we
particularly want to reverse it, obviously, with teens, not only because of
the importance of initiation at that age, but also because of how dangerous
these drugs are.

Q Just to try more to understand the -- I just called it the (inaudible)
survey, I don't even know what it's called anymore -- the (inaudible)
survey versus this one --

DIRECTOR WALTERS: Also, that survey was for -- it's important to point out
what it's trying to -- I think that I should mention that the survey that
was released there was for 2006. This is a 2007 survey, so they're
different time periods.

Q But you -- so if that cohort is 12 -- I just -- for people who don't
get into, like, cohort and how this is statistically analyzed, they read
our stories from three months ago saying, we're in danger of not making it
because prescription drugs use is negating everything. Twelve and older --
I mean, I was 12 when I was in 8th grade, so it's -- everybody says, oh,
the same group of people. And three months ago we were in real danger of
not hitting the goals, and today we're hitting the goals.

DIRECTOR WALTERS: Well, again --

Q I don't get it.

DIRECTOR WALTERS: Okay, maybe I could be clear this way. This survey is
about adolescents, and we're talking about trends within adolescents. I
would say that the household survey that you talk about, in terms of its
category of 12- to 17-year-olds, which overlaps the same age group, has
similar trends. It doesn't show exactly the same rates. The "Monitoring
the Future" survey, which was taken in schools, shows -- has consistently
shown some of the higher rates of reported use than the survey taken in the
household, although the trend lines have been the same. There are various
hypotheses for this; I'm not an expert, others can talk about what the
difference is. But we've seen similar trends, downturns, pretty steadily.
And they've been going down going back to '75, this is the longest
continuous survey instrument of its kind. But we've seen similar up-ticks.

What we were talking about at the Press Club was also not simply
adolescents, but adults. And the concern is people over 18 -- because we
also are concerned about them -- not seeing the same kind of declines,
largely as a result of the parent effect of additional prescription drug
abuse in the over-18 population at that time.

So maybe I could help you by just saying there is not an inconsistency as
long as you recognize one age group is adolescents, one age group is, kind
of, post-adolescent and adult.

Q This is for Dr. Volkow. What's the latest in the brain science
regarding -- I mean, one of the things that we've been talking about is how
difficult it has been to kick the OxyContin addiction -- there weren't
really good treatments available for narcotic addiction -- and also for
methamphetamine addiction. What things have changed in the brain science,
and what do we know now about treating folks with these types of
addictions?

DR. VOLKOW: Well, I mean, those are very important questions that we've
been trying to actually promote research to do it, specifically, the one,
what are the treatments for addiction to OxyContin? Addiction to OxyContin
is basically addiction to an opiate which, in a way, is similar to
addiction to heroin. And what we're doing now is evaluating -- for which
we have effective medication interventions, both methadone and (inaudible)
are very successful in the treatment of heroin addiction.

So currently we are doing a study, a large clinical study, to determine and
evaluate specifically the value of (inaudible) for the treatment of
addiction to opiates analgesics -- and that includes not just OxyContin,
but also Vicodin.

Now within that line of work, there's something that compounds the problem
and which is -- we haven't discussed it -- that what we've seen,
particularly in all the group of subjects that become addicted, in many
instances -- in some of those instances, they have become addicted after
proper prescription of the medication, because they suffer from chronic
pain. And the a challenge there for treatment is how do you intervene on
an individual that has severe pain, that needs potent analgesics, yet at
the same time is addicted to the medication that is likely to help him or
her perform better.

And that's a very unique situation that we have not experienced before, so
we're evaluating what may be the best interventions. And as of now,
(inaudible) is -- even though the studies have not been done -- is being
widely utilized for the treatment of patients that are addicted to opiate
analgesics.

Q And methamphetamine?

DR. VOLKOW: Methamphetamine addiction: We currently do not have any
medication that has proven to be effective in the treatment of
methamphetamine addiction. We have -- we're initiating several clinical
trials to evaluate promising medications, but we don't have any specific
results. We're also (inaudible) research to develop a vaccine that will
basically destroy methamphetamine when the person administers it -- it's
just like any other vaccine -- to interfere with relapsing an individual
sick in treatment.

That's what we have in the pipeline. What is that we have currently that
has been shown to be effective? Those are behavioral interventions, and
there is a program that has generated a lot of interest because it has very
good success, which is called the Matrix program. It's a multi-pronged
approach that addresses individual as well as group treatment
interventions; and that's one of them. We also have -- there's also
evidence of effectiveness of motivation and incentive therapies for the
treatment of methamphetamine addiction.

Q So what has been the change in attitudes regarding prescription drugs
among teens? Does the fact that they're -- you know, we're seeing a
leveling-off effect of illicit drugs suggest that teens are thinking that
prescription drugs are somehow safer, and that they're able to abuse them
more? And what are the demographics in that? Is it people that are -- you
know, is it in higher-income households, where they're able to afford these
prescription drugs, that teens are abusing these things?

DIRECTOR WALTERS: I think we can let Lloyd Johnston afterwards kind of
talk about the demographic data he has on this, because I think there's a
fair amount of it. What we've seen generally, and in working on prevention
messaging, with this research and other research, is young people have
reported that they understand -- this is where I think the efforts of
parents, the media, and others have been helpful -- that so-called street
drugs are dangerous: they can be dangerous for them to take; they can be
dangerous to them just because of what's uncontrolled and may be in them;
that the traditional drugs of abuse are something they have learned they
should avoid in greater numbers, and I think the numbers in this survey and
others reflect that.

But they have been told irresponsibly, or they believe that pharmaceuticals
-- because they come from a regulated industry, they come from a medical
establishment -- are safe, and they can actually go, on or their friends
have gone on irresponsible web sites that can suggest combinations of pills
to take for getting high so-called safely.

Now, again, these are synthetic opiates, as Nora said. They have a similar
effect on the body as heroin. They are powerful, many of them -- they are
particularly dangerous in combination with alcohol, which is not -- which
is a common combination with young people, as well as some adults. They
can be fatal, in addition to causing seizures and other problems, in
addition to addiction.

So, yes, we do need to some education. They think of these pills in a
different way and, as I said, the occasion to use them is greater because
-- they report -- they're in the house. They don't have to find somebody
to give them marijuana or cocaine or meth outside the home. They have them
in many kinds in their medicine cabinet, a medicine cabinet of a relative,
or a friend gets it for them. So the occasion is much greater, and that's
why we need to tell people to help, and they can take specific steps to
keep these under their control, throw away unused medications.

We want them -- again, we want people to have the best medical care. We
want people to be treated for pain. These medications, we understand, are
a godsend for many people that have been suffering chronic pain. But they
also have an abuse potential and we need to handle them with the knowledge
that that is there, and we can do things to have the benefit without the
harm. So I do think this is a unique opportunity for information to be
turned into more effective prevention and lower rates of abuse.